Sex after a heart attack: why many avoid it

After going through the experience of a life-threatening heart attack, many patients are justifiably terrified of having another—perhaps one they won’t survive—and some avoid sex for this reason. If their doctors took the time to discuss the resumption of sexual activity, however, women recovering from heart attacks have reported in a new study that they’d be far more likely to return to their former sex lives.

Unfortunately, very few cardiologists broach the topic of sex, especially with their female patients, according to research published this week in the Journal of the American Heart Association. Researchers extensively interviewed 17 female heart attack patients and found that very few of their doctors discussed resuming sex unless the women asked directly for guidance.

“These patients told us it would be easier to overcome their fears of sex after having a heart attack if their doctors gave them more information,” said study co-author Stacy Lindau, a gynecologist at the University of Chicago Medicine who specializes in treating sexual dysfunction in people undergoing cancer and other medical treatments.

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“Even providing just one sentence of counseling on this issue is so much more than saying nothing and can have a real impact on patient outcomes,” she added.

The new study builds on previous research also conducted by Lindau involving 1,900 heart attack patients who were surveyed about their sex lives after leaving the hospital. That study published last year found that only one-third of women and slightly less than half of men received hospital discharge instructions about resuming sexual activity. Those who didn’t get any advice were 44 percent more likely to report a year later that they still hadn’t resumed intercourse.

The American Heart Association issued landmark recommendations in 2012 advising cardiologists to discuss the resumption of sexual activity with heart attack patients. In the majority of cases, the panel of experts concluded, a heart patient’s risk of having a heart attack during sex was no greater than the risk faced by their peers of the same age without any heart problems. (Those with unstable angina or severe heart failure may need to get their doctor’s clearance to safely resume sex.)

A number of factors could explain why physicians and nurses fail to follow these recommendations, said Elaine Steinke, a professor of nursing at Wichita State University in Kansas who helped write the 2012 recommendations. “Medical providers may feel embarrassed or not view it as important enough information to include in a conversation before a patient is discharged from the hospital.”

But, she added, doctors can easily fold it into any recommendations they provide on physical activity. The Heart Association guidelines said the stress to the heart during sex is equivalent to climbing two flights of stairs.

New recommendations concerning the specific type of sex counseling doctors should provide are set to be released by the association on Monday.

In the new study, some participants mentioned that their sexual activity was less frequent but that their physical intimacy with their partner—all were in committed relationships—had increased since their heart attack. “I want to hold his hand more and snuggle more and have more hugs and stuff like that,” one woman told the researchers.

Others said having sex after their heart attack was life-affirming and helped them regain a sense of normalcy.

But many also had more fear and anxiety about how their bodies would handle the exertion, getting worried if their heart starting racing during foreplay. Spouses worried too. One woman said she had to convince her husband that she “wouldn’t die in bed.”

Another said she didn’t resume sex because she lost her libido, a side effect she attributed to the antidepressants she started taking to manage depression following her heart attack. A handful expressed concern over harming their healing surgical incisions.

“Any sort of invasive procedure on any part of the body has the potential to affect someone’s sexual function,” Lindau said. “If a healing wound is painful, patients will be more protective of that part of the body and avoid putting pressure on it, which may require new positions for sexual intercourse.”

While cardiologists may not want to delve into this much detail with their heart attack patients, they should make referrals to health care providers who do, Lindau emphasized.

“We’ve seen from this study and previous ones that patients—especially women—who aren’t counseled about sex after a heart attack are less likely to resume it,” Steinke said. “These findings are a call for health care providers to do more. They must make this part of a routine practice.”